Question: Hi,

My wife has a persistent cough and throat inflammation.

The history is as follows:

- around the 7th of January, she was infected with COVID. Symptoms were slight fever, pain in limbs and dry cough. She recovered from COVID around the 15th of January with cough as the only remaining symptom resolving.

- around the 19th of January, she developed coughing again which was more severe and this time seemed to develop phlegm. She saw a doctor on the 20th of January who diagnosed a bacterial throat infection. She was prescribed 625mg Amoxycillin/clavulanate (Curam) to be taken twice day for five days. She was also given Cophadyl-e syrup, Fedac tablets and Trotipont XXXXXXX lozenges.

Her coughing still persisted and was particularly serious at night and she saw a doctor again on the 23rd of January. The doctor said the signs of bacterial infection were not really there anymore and treated the nasal drip and inflammation with chlorpheniramine tablets to be taken at night for 5 nights, dextromethorphan syrup 10ml 3 times daily, fexofenadine tablets (180mg) to be taken in the morning for 5 days, serratiopeptidase 10mg tablets to be taken 3 times daily for 5 days and Trotipont Echinacea lozenges.

Her cough still continued to be quite severe at night and in the morning so she saw an ENT specialist who reviewed with a nasal endoscope and saw quite enlarged turbinates and also an inflamed throat (some pictures from the scope are attached). She was prescribed Nazolin 0.05% spray to be used twice daily with two sprays per nostril for alternate weeks, Avazmys spray to be used twice daily with two sprays per nostril and to be continued even when the Nazolin was stopped for one week after the first week, Rupatadine to be used twice daily and prednisolone 5mg (4 tablets each time twice daily) for 5 days.

Her cough is still persisting and likely mainly caused by nasal drip. Should she continue with the current medications prescribed by the ENT? Would saline sprays or steam be of assistance?

Will there be any issue with suddenly stopping the prednisolone after 5 days or should she taper off the medication? Could the prednisolone cause any issues as she also has slightly elevated blood pressure? Can she continue to take Ramipril tablets in the meantime? Generally for how long can Prednisolone be taken at current doses (40mg per day)?

Also is it ok to take antacids such as Gaviscon or will it interact with the antihistamine sprays and tablets?

Is the use of a steroid nasal inhaler such as Symbicort potentially helpful.



Thank you.

Dear Dr. XXXXXXX

Thank you for the information and opinion.

I will certainly look at gastric reflux as one of the main likely causes of my wife's throat inflammation.

Are there any distinguishing features of the images to differentiate the condition from nasal drip combined with post bacterial infection and heightened immune response especially after COVID infection? I noted that there were certain nodes or protruding nodules in the images.

After taking PPIs and antacids, the cough previously had been reduced but I did not see it as the main cause given that the nose was stuffy and appeared blocked to an extent. I will concentrate more on reflux as being a likely cause of the inflamed throat.

Thanks for the information on the current medications prescribed with conditions for their safe usage.



Thank you,
Regards.